Clinical education for hands-on practitioners

Make the comparison cleaner

I teach controlled reassessment, neurophysiology, and receptor-based clinical reasoning to practicing clinicians

Start with a practical worksheet for cases that improve briefly, change inconsistently, or stop moving forward

Open the free worksheet 10-page printable PDF. No signup required

Upcoming webinar Late August or early September. Details after confirmation

Dr. Alex Atiakshev · Clinician educator · P-DTR instructor

15+ years in manual practice
P-DTR since 2017
Instructor since 2023

Why this site exists

I give experienced clinicians a stricter way to compare what changed, what repeated, and what the observation can support

I have 15+ years of manual and osteopathic practice, began P-DTR training in 2017, and became a certified instructor in 2023. The materials here focus on reassessment, sensory input, and clinically defensible reasoning

Manual practice: 15+ years
Graduates: 200+
P-DTR training: Since 2017

Four ideas the practice is built on

The symptom is not the cause

The location of a symptom and the variables influencing it are not always the same. The clinician's job is to hold more than one hypothesis, control the comparison, and reassess before deciding what the observation supports
Compensation carries a structural cost over time

The nervous system adapts to changing load and sensory information. Those adaptations are useful clinical context, but they remain hypotheses until a repeatable comparison changes the working interpretation
Sensory input is the upstream control variable

Vision, the vestibular system (inner-ear balance), proprioception (sense of joint position and movement), the skin: these afferent channels (signals traveling from sensors into the nervous system) write posture, load perception, and motor output. A controlled sensory challenge can therefore be used as one part of reassessment
P-DTR is principled diagnostic reasoning

Proprioceptive Deep Tendon Reflex (P-DTR) is a receptor-based clinical-reasoning and assessment method. It reads how receptors are firing (the sensors in joints, skin, muscle, eyes, and ears) to examine whether a specific sensory input changes a defined clinical reference. It is an educational assessment framework, not a treatment for a symptom or disease

A symptom location is one observation, not the full explanation. Reassessment asks what changes when one variable changes
Working frame · Pro Prio Lab

Diagram: a misreading sensory receptor drives a symptom felt elsewhere in the body — Diagram · the symptom is not the cause

Selected cases

Four cases. One reassessment question

Four educational single-case observations showing how a clinician can test an afferent-input hypothesis without presenting it as causation or a promised outcome

01

Hidden vestibular dysfunction behind unexplained balance loss

The patient reported intermittent balance loss, with symptoms emerging only under specific load conditions. Receptor-based assessment and stabilometry considered asymmetric vestibular afferent input as a possible contributing factor, reported as a single-case observation

Balance · Vestibular · Posture
02

Persistent dizziness and receptor-based clinical reasoning

The patient presented with episodic dizziness, light sensitivity, and sound intolerance - receptor-based assessment considered asymmetric afferent input with predominantly cervical and occipital findings as a possible contributing pattern

Vertigo · Sensory overload
03

Chronic neck pain considered through visual input

Prior local approaches had not produced stable change - receptor-based assessment considered visual afferent input as a possible contributor to a cervical compensation pattern

Neck · Visual · Chronic
04

TMJ and knee symptoms considered through visual input

A recent eye injury was followed by TMJ symptoms and knee discomfort - receptor-based assessment considered visual afferent input as a possible primary contributor to the postural compensation pattern through the jaw and knee

TMJ · Knee · Visual

Read all eleven cases

What hurts is the compensation. The driver lives upstream in the sensory map

Teaching · receptor-based reasoning

Essays on physiology and clinical thinking

13 min read Neurophysiology

One Principle, Different Levels: How the Nervous System Decides What Matters

A neurophysiology essay tracing competitive weighting and integration from retinal center-surround organization to spinal WDR neurons and sensory reweighting
11 min read Somatosensory physiology

Mechanoreceptors Work in Pairs: Why the Unit of Perception Is Not a Receptor

A somatosensory physiology essay on paired RA and SA channels, mechanoreceptor convergence, muscle-spindle coding, and the limits of clinical frequency maps
10 min read Clinical reasoning

The invisible nociceptor

A nerve fiber can fire for years without producing pain - and quietly drive tension, fatigue, sleep, and mood along the way. A clinical framework for complaints that won't localize on imaging
12 min read Neurophysiology

Why the scar still matters

The dorsal-horn amplifier that lets a healed injury keep running the body for years. A field guide to WDR neurons, wind-up, and central sensitization
18 min read Postural system

What the skin of the foot is actually doing

A physiology essay on the four cutaneous mechanoreceptors of the sole - and why the mechanics of the skin itself shape postural control as much as the nervous system does

A receptor-based assessment room — Receptor-based practice · the working frame

Training for clinicians

The method, taught

A structured P-DTR curriculum in neurophysiology, assessment, and receptor-based clinical reasoning for qualified clinicians

Clinicians studying receptor-based reasoning — Studying receptor-based reasoning

Base course 5 seminars · 3 days each · ~8 months

Five seminars. Thirteen modules. Built around receptor-based clinical reasoning

Theory is paired with hands-on practice, supervised comparison, and maintained clinical manuals across the full curriculum

Introduction and principles · Tools and rules of P-DTR · Muscle-receptor algorithms · Nociceptor work and inhibition patterns · Ascending tracts · Golgi, Pacinian, Ruffini, Meissner, Golgi-Mazzoni, Krause · The neurology of gait · Pelvis, spine, and major joints · Cranial dysfunctions · Meridian work (segmental referred-pain mapping) · Visceral and autonomic applications · Emotional reflexes (limbic-autonomic responses affecting motor output) · Clinical reasoning

Master-class 1 day

Introduction to P-DTR

A single day to leave with Pro-Prio tests as a fast-triage tool, the core rules of the method, and enough foundation to begin working with nociceptor-driven patterns within your existing scope of practice

Taught in 2 countries

Germany

Seminars are currently taught in Germany. Certification is conferred directly by the founder of the P-DTR method, Dr. José Palomar, after completion of the full curriculum and the author-led examination

For whom Clinicians

Clinicians and manual therapy professionals

For practitioners working in manual therapy, rehabilitation, movement, and sports medicine who want to understand receptor-based clinical reasoning within their existing scope of practice

Dates by email

Apply to train with me

For hands-on clinicians who work with muscle, movement, and pain - manual therapists, chiropractors, physical therapists, clinicians in movement and rehabilitation, sports medicine clinicians, osteopaths, massage therapists, and applied kinesiologists